Botulinum toxin treatment for acute traumatic complete sixth nerve palsy

Aims To investigate the benefits of botulinum toxin (BTX) injection for acute unilateral complete sixth nerve palsy caused by trauma. Methods We retrospectively reviewed patients treated for acute unilateral complete sixth nerve palsy caused by head injury during a 10-year period (between March 1993 and February 2003) in our hospital. The BTX treatment group was defined as patients who received BTX injection within 3 months of injury. Patients who presented within 3 months of trauma, and had no previous BTX injection or surgery were enrolled as the conservative treatment group. Comparison of the patient demographics, palsy characteristics, angle of deviations, and recovery rates were made between the two groups. Results In all, 33 patients were enrolled by our inclusion criteria. Of these, 19 patients were treated conservatively, and 14 patients were treated with BTX. A total of 79% of our patients presented with abduction deficit of grade -5. The results showed that there was no significant difference in the outcome for the two groups based on age, gender, time to presentation, severity, and initial angle of deviation. The BTX group had a higher recovery rate than the conservative treatment group (64.3 vs 26.3%, P = 0.028). Among 26 patients with grade -5 abduction deficit, the recovery rate was higher in the BTX-treated patients than in the conservatively treated patients, which had no statistical significance (50 vs 18.8%, P = 0.09). Conclusion BTX facilitates recovery of acute traumatic complete sixth nerve palsy in severely injured patients.